92 Decision Citation: BVA 92-06545
Y92
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 91-43 457 ) DATE
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THE ISSUE
Entitlement to service connection for an acquired
psychiatric disorder, variously diagnosed.
REPRESENTATION
Appellant represented by: Veterans of Foreign Wars of the
United States
ATTORNEY FOR THE BOARD
Frank L. Christian, Counsel
INTRODUCTION
This matter came before the Board on appeal from rating
decisions of December 1989 and December 1990 from the
Wichita, Kansas, Regional Office (hereinafter RO). The
veteran served from September 1974 to September 1978 and
from October 1984 to August 1989. The notice of
disagreement was received in January 1990. The statement of
the case was issued in March 1990. The substantive appeal
was received in May 1990. A supplemental statement of the
case was issued in December 1990. Following receipt of
additional medical evidence, another supplemental statement
of the case was issued in July 1991. The appeal was
received and docketed at the Board in September 1991. The
appellant has been represented throughout this appeal by
Veterans of Foreign Wars of the United States. That
organization submitted additional written argument to the
Board in February 1992, and the case is now ready for
appellate review.
CONTENTIONS OF APPELLANT ON APPEAL
The appellant contends that the RO committed error in not
granting service connection for his currently manifested
acquired psychiatric disorder, variously diagnosed, because
it did not take into account or properly weigh the medical
evidence of record. It is contended that the service
medical records show that the appellant received inservice
psychiatric treatment and a subsequent medical discharge due
to an acquired psychiatric disorder, that such disorder
continues to be manifested, and that service connection is,
accordingly, warranted for this disorder.
DECISION OF THE BOARD
For the reasons and bases hereinafter set forth, it is the
decision of the Board that the preponderance of the evidence
supports a grant of service connection for an acquired
psychiatric disorder, variously diagnosed.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the instant appeal has been obtained by the
RO.
2. An acquired psychiatric disorder, variously diagnosed,
was manifest during active service, at the time of final
service separation, and on current Department of Veterans
Affairs (VA) psychiatric evaluation.
CONCLUSION OF LAW
An acquired psychiatric disorder, variously diagnosed, was
incurred during peacetime service. 38 U.S.C. § 1131.
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Board finds initially that the appellant's claim is
"well grounded" within the meaning of 38 U.S.C. § 5107(a);
that is, it is not inherently implausible. We also find
that the facts relevant to the issue on appeal have been
properly developed and that the statutory obligation of the
VA to assist the appellant in the development of his claim
has been satisfied. 38 U.S.C. § 5107(a). On appellate
review, we see no areas in which further development might
be fruitful. While the appellant's service medical records
do not appear to be complete with respect to his second
period of active service, the Board finds that the medical
evidence of record is adequate to resolve the issue
currently on appeal.
In order to establish service connection for claimed dis-
ability, the facts, as shown by evidence, must demonstrate
demonstrate that a particular disease or injury resulting in
current disability was incurred during active service or, if
preexisting active service, was aggravated therein.
38 U.S.C. §§ 1110, 1131. However, personality disorders are
one of a category of developmental defects for which VA
disability compensation benefits are not payable. 38 C.F.R.
§ 3.303(c).
The veteran's service medical records show that during his
second period of active service, he began to develop and
exhibit behavior consistent with a depressed or dysphoric
mood, with discontinuance of his assigned responsibility and
explosive behavior. On emergent psychiatric evaluation, he
complained of middle and early morning insomnia, decreased
libido, diminished concentration, weight gain, and hopeless
and helpless feelings. On mental status evaluation, he
appeared fatigued and distraught. His mood was disgruntled
and depressed, and his affect was congruent. Thought
content centered around his working conditions and his naval
career, and he exhibited aggravation and frustration.
Psychological testing with the Minnesota Multiphasic
Personality Inventory was indicative of a chronic depressive
condition, while the Millon Clinical Multiaxial Inventory
suggested dependent personality traits.
Following admission to a psychiatric ward, the veteran's
symptoms improved with individual, group and milieu
psychotherapy. In individual counseling sessions, he
maintained that conditions aboard ship were "sub-human."
While displaying no evidence of a psychotic disorder or of
suicidal or homicidal ideation, he refused to participate in
a stress-coping group, outpatient psychotherapy, civilian
marital counseling, or biofeedback sessions. After an
adequate period of observation, evaluation and treatment, a
conference of staff psychiatrists determined that the veteran
suffered from a transient condition which had largely
resolved upon removal from the environmental stressors, and
for which he refused any form of extended psychotherapy.
The primary diagnosis was adjustment disorder with depressed
mood, treated, improved, did not exist prior to service,
manifested by a depressed mood, middle and early morning
insomnia, decreased libido, diminished concentration,
increased appetite with weight gain, helpless and hopeless
feelings, and transient suicidal thoughts. The precipitating
stress was described as routine military service, including
18-hour workdays in adverse environmental conditions. Other
diagnoses included episodic alcohol abuse, remote, when
lonely, fatigued or distressed; and dependent personality
traits, manifested by decreased ability to function in the
absence of his wife, including a strong need to be near or
with her at the expense of his career. The Medical
Evaluation Board determined that the veteran was unfit for
further naval service as a result of these conditions. A
Physical Evaluation Board, convened in May 1989, concurred
in these findings and diagnoses.
On VA psychiatric evaluation in December 1989, the
appellant's history of inservice psychiatric problems and
treatment was noted. Mental status examination was
unremarkable. The diagnosis was adjustment disorder with
depressed mood, resolved.
A report of VA social and industrial survey, conducted in
September 1990, cited a history offered by the veteran of
inservice treatment and subsequent service separation for
psychiatric problems. He stated that he had experienced a
"nervous breakdown" following an episode of lost boiler room
power aboard ship, as well as failure of his marriage. His
current complaints included becoming irritable and angry
around family members.
A report of VA psychological testing in April 1991 noted
responses suggestive of intense feelings of insecurity, easy
distractibility, diminished concentration, feelings of
worthlessness, diminished ego strength, and vulnerability to
anxiety, culminating in severe depression.
A report of VA psychological evaluation, conducted in April
1991, cited a history offered by the veteran of having
become confused, overwhelmed and angry after an incident
aboard ship in which a loss of ship's power occurred. His
complaints included difficulty sleeping, depression,
tearfulness, suicidal ideation, and irritability. Mental
status evaluation disclosed that he was well oriented, with
clear and well-organized speech and organized and linear
thoughts. His affect was fluid and appropriate to thought
content. There was some sense of depression and he
complained of frequent depression, moodiness and crying, as
well as feeling bored, lonely and numb. He related episodes
of tearfulness to television stories concerning divorce or
family issues. He denied hallucinations or delusions.
Concentration was excellent, recent and remote memory was
intact, abstract reasoning was quite adequate, judgment was
good, and some insight was present. The diagnosis was
post-traumatic stress disorder, chronic, with depression.
The Board has carefully considered the contentions and the
medical evidence in this appeal. We do not agree with the
diagnosis of post-traumatic stress disorder, finding that
the medical evidence of record does not reflect the presence
of an adequately documented stressor, and further finding
that the symptoms exhibited by the veteran do not meet the
diagnostic criteria for post-traumatic stress disorder.
American Psychiatric Association: Diagnostic and
Statistical Manual of Mental Disorders, 3rd ed., revised
(1987). However, the medical evidence of record documents
the presence of psychoneurotic symptomatology during service
and subsequent to service and supports a finding that the
veteran had a neurosis in service and has a neurosis at the
current time. As long as the evidence supports such a
finding, a legal basis exists for granting service con-
mection for a neurosis. At this point, the precise diag-
nostic classification is essentially academic. Based upon
the clear documentation of this psychoneurotic disorder
during the veteran's second period of active service, the
Board finds that service connection for an acquired psycho-
neurotic disorder, variously diagnosed, is warranted.
The Board finds that the positive evidence outweighs the
negative evidence in this case and that the appellant has
satisfied the burden of proof required for favorable action
on appeal.
ORDER
Service connection for an acquired psychiatric disorder,
variously diagnosed, is granted.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
*
GEORGE R. SENYK
BRUCE E. HYMAN
(CONTINUED ON NEXT PAGE)
*38 U.S.C. § 7102(a)(2)(A) (1991) permits a Board of
Veterans' Appeals Section, upon direction of the Chairman of
the Board, to proceed with the transaction of business
without awaiting assignment of an additional Member to the
Section when the Section is composed of fewer than three
Members due to absence of a Member, vacancy on the Board or
inability of the Member assigned to the Section to serve on
the panel. The Chairman has directed that the Section
proceed with the transaction of business, including the
issuance of decisions, without awaiting the assignment of a
third Member.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C. § 7266 (1991),
a decision of the Board of Veterans' Appeals granting less
than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals
within 120 days from the date of mailing of notice of the
decision, provided that a Notice of Disagreement concerning
an issue which was before the Board was filed with the
agency of original jurisdiction on or after November 18,
1988. Veterans' Judicial Review Act, Pub. L. No. 100-687,
§ 402 (1988). The date which appears on the face of this
decision constitutes the date of mailing and the copy of
this decision which you have received is your notice of the
action taken on your appeal by the Board of Veterans'
Appeals.